I recently wrote about how they are only now finding certain abdominal wall injections work for chronic abdominal pain in adults – confirming source is the abdominal wall – what already???

I suspect it is even worse with children in which 30% of chronic abdominal pain is thought originated from the abdominal wall and amenable to injection. Study in press documents features and treatment.

Recent study gave a breakdown of what they found re cause. Frank diabetes was eliminated from selection as the cause would be obvious? Top 4 were Idiopathic 47%, Chronic Demyelinating Inflammatory Polyneuropathy(CIDP) 38%, Pre-diabetes 16%, and Charcot Marie Tooth syndrome (CMT) 9%.

Approximately 40% of “Fibromyagia” cases are actually small fiber neuropathy (SFN). There is now evidence of how this type of neuropathy progresses. 75% remain stable and 25% progress into large fibers.

Intramuscular Needle electrical needling of trigger knots in rat gastrocnemius(calf) results in less irritable sites. I use IMS for areas I wish to avoid use of local (neck, about hip where need to be able to walk after etc.). I couple it with massage techniques to remove any residual triggers and find it helpful. Nice to have some basic science showing it works.

Results from simple measures such as heel cup and ankle dorsiflexion night splint are not vigorous so am forced to look further. Steroid injection in the 21st century is out because it thins the heel pad making further problems more likely. I came across this protocol for PRP that is simple and could be done by anyone with a centrifuge. All PRP studies of plantar fasciitis only talk about long term results so I suspect immediate gratification like one gets from steroids, is not likely. It uses small amounts (from 10 mls blood) weekly x3.

I have now seen 2 cases of idiopathic cervical “sciatica”/radiculitis with stickingly bad pains in triceps. This arm muscle pains can help distinguish this from intrinsic shoulder pains and one author some years ago came up with the arm “squeeze” test for neck radiculitis

Opioid deaths seem to be fueling more by Chinese derived illicit fentanyl. However, massive efforts are made to lower opioid dose. One study was successful at getting opioid consumption down from 288 mg to 150 mg. They weren’t any better for it despite the theoretically “dangerous high levels” which would probably not be a problem if they avoided chinese imports. There was no effort to have a control group to see how many more deaths there were in the “dangerously high” group.

I have not had much luck tapering opioids and a recent analysis explains why. They claim opioids are integrated in mood, energy, motivation, social functioning and personality systems and withdrawing doses will effects all of it. Above study was successful because they started with 5% reductions in the first month and upped it to 10% every 2 weeks in the second month.

It has been said Opioids and tranquilizers can increase risk of overdose death five fold.
In my population, there is a subgroup of cases with bipolar disorder. Indeed, a meta-anlysis found 21 – 25% of Fibromyalgia disorder have it and I suspect more not diagnosed. In a mixed state, a pain patient gets little sleep and is in considerable distress with agitation and will inadvertently be put on significant doses of tranquilizers to deal with this “pain” when tolerance to atypical anti-psychotics is limited. March is a good time to see it and I have seen a couple cases already this year. After the mixed state subsides, they end up continued to take them because they can contend it helped them.

It is also easy to put pain patients that don’t sleep and have restless legs, on Clonazepam which is some cases is dangerous, particularly if subjects are obese and subject to sleep apnea.

Pain became the 5th vital sign and doctors were initially told to take tabs on severity through scales out of 10 testing. Now, out of fear severity analysis will over-treat pain with opioids, doctors in USA are being encouraged not to question pains severity and stick to level of function. There is evidence that, removed from placebo effect, opioids only reduce pain by 1/10 on average. For clinicians that are not trained in orthopedic medicine, opioids, and now marijuana, are the main tools to control pain. This is what fuels the opioid epidemic. I did an analysis of my practice and find other measures I do drops pain by 2/10 bringing pain to more acceptable levels. Those with 7/10 of more can be often dropped in pain by 3/10 for 3 days at a time by ketamine shots done 1-2 times a week and control depression. Regular treatments using alternatives written in this blog, can do more.

Article starts by mentioning how up to 33% of cholecystectomy patients can have persistent abdominal pain so taking out Gallbladder (GB) is a serious decision. Indications however include frequent attacks, large stones, older age, inflamed GB attack(cholecystitis), and pancreatitis from gallstones.

Although the question of whether one is dealing with hip bursitis or is this referred from back is important, I wanted to clarify what steroid injection would do for seemingly glutues medius bursitis. One study suggests it was good in 72% of cases at one month while another suggested it was good up to 6 weeks. Thereafter however, is problematic with PRP injection outshining it after 6 weeks. Problem is and I quote “an isolated passive intervention cannot hope to address the often complex mix of pre-existing and subsequent impairments”.

A Canadian study on full thickness tears found the no-op subgroup did well over 5 years. A Netheraland study found removing bursa (B) and taking off acromium(A) not any better than just removing bursa alone in chronic subacromial shoulder pain. Tear progression was not statistically different though at trend for A+B. Both suffer from not examining the patient subsequently to see what troubles they did actually have. British study found no clinically relevant benefits to Arthroscopic sub-acromial decompression

Looking for cheap and easy techniques to treat pain, I came across a treatment for back pain using the slump test. Sitting with legs out straight and your feet flat against a wall, you slump forward and put your head down. If your back pain radiates into the buttocks this would suggest that your dural spinal lining is irritated and doing the slump regularly can “floss” free any adhesions and help the back pain..